checking BP before giving BP meds?

  1. do you guys always check BP before giving BP meds?

    Because on my unit, for 9am meds, nurses go off the 7am VS.


    Also, if there are parameters such as "do not give is SBP is <110 or HR is less than 60"---- do you still give it if their BP is still high but their HR is low?

    some nruses would say "don't give it because HR is low", and other nurses say, "you should still give it because their BP is high and it helps stabilizes the BP and especially if they are a-fib or have any heart problems--THEY STILL NEED IT"


    what do you guys do? follow one or the other parameter or still just give it because they have heart problems despite the BP and hR?
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  2. 22 Comments

  3. by   CT Pixie
    Quote from 2bnurse_it
    do you guys always check BP before giving BP meds?

    Because on my unit, for 9am meds, nurses go off the 7am VS.


    Also, if there are parameters such as "do not give is SBP is <110 or HR is less than 60"---- do you still give it if their BP is still high but their HR is low?

    some nruses would say "don't give it because HR is low", and other nurses say, "you should still give it because their BP is high and it helps stabilizes the BP and especially if they are a-fib or have any heart problems--THEY STILL NEED IT"



    what do you guys do? follow one or the other parameter or still just give it because they have heart problems despite the BP and hR?
    I always do my own BP for pts on BP meds. What good is a 7am BP at 9am? BP can drop between those hours. Best to do your own. (and I don't have my UAP take the BP for me, I take it myself, right before giving the med)

    If the paramaters read if SBP < than XXX or HR < 60, you shouldn't give it if either of those two things falls in those ranges. Thats why the or is there, the doc doesn't want it given if one or the other is occuring. If the doc felt that the pt still needed the BP med even with a HR <60 he/she wouldn't have put in the or HR>60.

    I've held plenty of BP meds with HR<60. Never had a word said by any other nurses and when I call the doc to inform him, he's fine with it.

    The way I see it is, its MY license on the line if I tank someones BP because I relied on an old BP, or I do harm because I gave a BP med even with a decent BP but a slow HR. And thinking about it, if you do give it with a decent BP but low heart rate, aren't you in a sense practicing medicine without a license? Because you are, in fact, going against the docs order.

    Just my from a new nurse.
  4. by   FireStarterRN
    It depends on a lot of factors. Fortunately, on the unit where I've been working most BP meds are given at 10 AM and the scheduled VS are at that time.

    If the pt has been stable, hasn't gotten started on the new regieme, isn't have volume depletion problems, LOC is unchanged, didn't have a marginal previous BP, then I'll go by the one two hours ago.

    If they have parameters, I always take it right before. If their last BP was 160/90 and they are a stable pt, then time prioritization would probably point in the direction of going by the previous set of VS.

    Blood pressure tends to be highest before the next dose of HTN med. But, lets say they got started on lasix, which is always given first thing in the AM, or they got a large dose, then that could bring down the BP. Let's say their AM BP was 105/58 and they got their 8AM lasix, then definately recheck.
  5. by   suzy253
    Absolutely check BPs & pulse before giving cardiac meds. I work 3-11 and patients get meds at 2100. I take their BP & pulse and record it on the med sheet.
  6. by   dmp135
    Quote from 2bnurse_it
    do you guys always check BP before giving BP meds? Because on my unit, for 9am meds, nurses go off the 7am VS.
    Also, if there are parameters such as "do not give is SBP is <110 or HR is less than 60"---- do you still give it if their BP is still high but their HR is low?some nruses would say "don't give it because HR is low", and other nurses say, "you should still give it because their BP is high and it helps stabilizes the BP and especially if they are a-fib or have any heart problems--THEY STILL NEED IT"
    what do you guys do? follow one or the other parameter or still just give it because they have heart problems despite the BP and hR?
    YES.
    You would have a hard time defending that if something happened. Ask yourself, if it were my relative and something happened, would I find that acceptable that the RN used vitals 2 hrs old before cardiac meds?

    Actually I always call even just to say I held it. Sometimes they will decide to give an alternative med. This happens quite often with lopressor and hydralazine when there are mixed BPs and HRs that warrant questioning.

    As I mentioned, I call and ask them that way I don't have to wonder about the "what ifs".

    Dorothy
  7. by   2bnurse_it
    thanks guys.

    yea, i always have a hard time especially when patients are receiving like 2 or 3 bp meds. According to my preceptor, it helps stablizes the bp. but does it matter if they have a heart problem, where in that case, are we to "give it" despite a low bp?

    that's what my preceptor tells me.
  8. by   Kymmi
    Always always check the B/P and heart rate prior to giving any B/P med or med that will affect the heart rate. No I would not go on the vitals from 2 hours ago because let's assume that you did and gave the med and patient coded secondary to cardiac arrest due to hypotension/bradycardia when that chart went to court the attorney is going to ask why the b/p or heart rate was not checked prior to adminstration of the medication. If you respond it was checked 2 hours ago you can bet he is going to come back with a question to you of how can you prove that patient was ok when you gave the med. It will all be in the domentation and if you have a B/P charted for 7 am and a b/p med for 9-10 am without any b/p charted it will be proven that it was not checked...so bottom line if you want to cya then check AND document the b/p and heartrate at the time of adminstration.

    Second question......no...if the B/P is elevated but you have a heart rate of 56 and you give lets say lopressor sure your b/p will come down but you can also bet you are going to have a heart rate in the 40's also so hopefully you have your pacerpads ready to go. Now if the b/p is high and its vasotec or hydralazine ordered then yes..go ahead and give it because those drugs do not affect heart rate. The same rule goes for the above poster who asked about several different meds ordered for b/p....go with the one that does not affect the heart rate if the heart rate is low and b/p is high or vice versa.
  9. by   mcknis
    I always check my BPs before giving BP meds. Those pressures can change in an instant and if you are the kind of nurse who isn't on top of your pts, then shame on you. i know it is hard at times to do that, but you have to stay up on things! There are times when I know the pt has been doing well and they are on, for instance, Cozaar at home and are getting their daily dose at 1000, but BP hasn't been checked since 0800 (148/93; HR 80), I'll go ahead and give it, since they are used to it at home. But of course if the pt is symptomatic of being low, then I'll check and do my standard nursey things. You have to judge each condition individually. Had another pt the other day who's BP meds were titrated by cards, PCP and nephro and when all was said and done, she was going to be getting 100mg of Hydralazine and 80mg IVP Lasix at the same time. Of course I checked BP between these meds...
  10. by   nursealanarae
    Quote from mcknis
    I always check my BPs before giving BP meds. Those pressures can change in an instant and if you are the kind of nurse who isn't on top of your pts, then shame on you. i know it is hard at times to do that, but you have to stay up on things! There are times when I know the pt has been doing well and they are on, for instance, Cozaar at home and are getting their daily dose at 1000, but BP hasn't been checked since 0800 (148/93; HR 80), I'll go ahead and give it, since they are used to it at home. But of course if the pt is symptomatic of being low, then I'll check and do my standard nursey things. You have to judge each condition individually. Had another pt the other day who's BP meds were titrated by cards, PCP and nephro and when all was said and done, she was going to be getting 100mg of Hydralazine and 80mg IVP Lasix at the same time. Of course I checked BP between these meds...
    I agree! It all depends on what the patient does at home. They know their body better than we do. Usually if the VS were done less than an hour before I give the med, I don't re-check it. If their BP isn't their baseline or too low/high. I check it myself. I ALWAYS take it manually. I check heartrate as part of my assessment on all patient's. Do what you think is right. It's your license.
  11. by   WDWpixieRN
    We weren't allowed in school to admin a BP or heart med without taking a current reading and charting same. It was a pain in the a$$ a lot of the time, but when an instructor accompanies you each time you give you ASA, you do what is expected.

    I have been off orientation for 3 months now, and you can bet your bottom dollar that regardless of how busy I am, I grab the machine and head in for a current BP and take their HR. That few minutes of time may save a pt's life AND my license.

    I'm thinking as one poster responded that I might result to the manual pressures. That was not my strong suit in school and it would probably be good to hone my skills doing so.
  12. by   jjensen
    I always take my own BP and HR... I worked on a cardaic floor and some MD's wanted the HR low etc... I would call them and let them know and see if they still wanted me to give them... It is my license and I am NOT going to risk giving a med if it states not to give it. The orders are there for me to follow...
  13. by   sofaraway04
    I wouldn't give the med and would call the DR to inform them that I hadn't given it, then document the conversation right away. I would then recheck the BP and HR in approx and hours time, because if it was low then it might point towards something going on with the patient.

    When giving BP meds I will go on the BP taken at 6-7am when I give the meds at 8am unless it was very low or high then I will re-check it. when giving meds to 12 pateints probably 8 of them would be on BP meds, I would never finish my med round if I took all of those BP's myself.
  14. by   nyrn5125
    I am on a telemetry floor so if it was within the hour and the patient has not really changed activity since the last BP reading or if it's a good number then I can use it. If BP reading 90/50 but the med says hold for bp<90 then retake.If they have stood up since the last reading then I retake it manually. (i have had vagal or orthostatic reactions) not worth bottoming them out to 60/40 and HR 35. I know hospitals stress getting meds out quick but your patients care more about how they are treated when they are in your care.Also I have had those auto bp machines with terrible readings, they aren't as accurate. So be careful

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